Outline

The German Pension Insurance Company (DRV) introduced a comprehensive program to develop guidelines for rehabilitation. A part of this program involves the compilation of guidelines especially for therapeutic interventions during the rehabilitation of breast cancer patients. This project is divided into 4 phases: (1) A systematic review of the literature (Medline, Psyndex, PsychInfo, CINAHL, DIMDI and EBMR) was carried out. Approximately 200 articles could be extracted for systematic analysis and 14 therapeutic modules could be created. These articles were evaluated according to the Oxford Levels of Evidence. Considerable differences were found in terms of the levels of evidence for the 14 therapeutic modules. Whereas good levels of evidence were found for "relaxation techniques", "sport therapy" and "psycho-social counselling", "lymph drainage" and "art therapies" had only a low level of evidence. (2) In phase 2 an analysis of the treatments in rehabilitation hospitals was carried out using data from routine documentation according to the Classification of Therapeutic Procedures (KTL). 214 out of 840 possible KTL-codes could be matched to these modules. These analyses were based on 24685 patients in 57 rehabilitation hospitals, treated in 2003. It was found that “physiotherapy”, “sport therapy” and “education” were provided to the majority of the patients. Younger patients received more treatments than older patients and patients with more comorbidities received more “physiotherapy” and “lymphoedema therapy” than patients without comorbidities. Data analysis shows a wide intra- and interindividual variability with regard to the therapeutic modules. Also, there are great differences between rehabilitation hospitals concerning the availability of treatments. (3) In phase 3 a systematic survey was carried out with experts in breast cancer rehabilitation. Questionnaires were sent to 73 rehabilitation hospitals, 31 professional organizations and 2 self-help organizations of breast cancer patients. The return rate of the questionnaires was 81,6%. All those asked agreed to the modules and most of them were in accordance with the frequency and duration of the treatments. A consensus conference with 32 experts from clinical and research areas of rehabilitation is planned for January 2006 in Berlin. (4) Implementation and evaluation of the guideline in rehabilitation hospitals will be the last steps of the project and are planned for 2006.